Candidate: Dr. Schoenfeld is an Assistant Professor and Associate Orthopaedic Surgeon in the Department of Orthopaedic Surgery at Brigham and Women?s Hospital (BWH). He is a graduate of the Robert Wood Johnson Clinical Scholars Program at the University of Michigan. Dr. Schoenfeld has a successful track record of publishing in peer reviewed journals and presenting original research at national scientific meetings. He has an experienced team of mentors and collaborators combined with strong institutional support in a rich academic environment that has successfully trained other clinician scientists in patient-oriented researchUnder the guidance of his mentoring team, led by Dr. Jeffrey Katz, Dr. Schoenfeld will obtain training in causal inference techniques, qualitative research methods, and decision analysis in order to complete the aims outlined in this proposal. The research training, mentorship, and results that arise from this project will help Dr. Schoenfeld achieve his long-term goal of maturing into an independent clinician scientist in the field of spinal metastatic disease and musculoskeletal medicine. Environment: Dr. Schoenfeld has a commitment from the Department of Orthopaedic Surgery at BWH that ensures at least 60% protected time for the research and career development activities outlined in this proposal. He has access to patients with spinal metastases for recruitment in the focus groups outlined in Aim 2 through collaboration with surgeons and oncologists at BWH, Massachusetts General (MGH) and the Dana Farber Cancer Center (DFCC). Since these three centers are leading academic institutions with a specialty focus in musculoskeletal oncology, he will have access to recruit adequate numbers of subjects for this project as well as future research. He has access to experts in causal inference and decision analysis techniques including Drs. Miguel Hernan and Elena Losina. At HSPH, Dr. Schoenfeld will obtain formal didactic training in causal inference, programming, qualitative research methods, and decision analysis to enhance the research skills necessary to complete this proposal. Research: At present, the literature lacks research that integrates the effects of spinal metastatic disease and its treatment with patient preferences for outcomes. In this K23 proposal, Dr. Schoenfeld will perform a cohort study where causal inference testing is used to adjust for confounding by indication, conduct focus group sessions to help understand patient preferences for treatment in the setting of spinal metastases and perform a decision analysis that will highlight the value of operative and non-operative treatment for specific types of patients. By enhancing appreciation for factors that can inform treatment for an individual with spinal metastases, as well as understanding of the factors that drive decision making for both patients and physicians, this mixed methods proposal has the potential to substantially influence patient care.